Insurance Case Manager Jobs in Lancaster, PA (NOW HIRING)

The Nurse Case Manager is responsible for for care coordination of patients who are identified as high or potential high utilizers of the system. Case management should be focused on the integration of services and improving the continuity of care and outcomes for those clients. The Nurse Case Manager will play a pivotal role in leading our Medicare Shared Savings Program efforts, promoting preventative wellness services and ensuring effective care coordination across the continuum of care. The Nurse Case Manager is also responsible for managing the SBIRT (Screening, Brief Intervention, and Referral to Treatment) program and care coordination for patients with addiction needs. This position will assist providers with clinical tasks within the Maryland Board of Nursing scope and standards of practice.

If you’re looking to work for an organization that offers great benefits, growth opportunities and a positive atmosphere, this is the job for you!

WHY SHOULD YOU APPLY?

• Growth and Advancement Opportunities
• Company Sponsored Events
• Employee Engagement Committees
• WCHC offers a compressive benefit package including:
  1. Medical, Dental, and Vision insurance
  2. Health Reimbursement Arrangement
  3. Employer paid Life and AD&D and Disability insurance
  4. 401K with employer match
  5. Generous Paid Time Off and Volunteer time
  6. Paid Holidays
  7. Education reimbursement

PRIMARY ACCOUNTABILITY

• Achieve Results
  1. Coordinate and execute care plans on high risk patients
  2. Establish, maintain, and monitor the outcomes of SBIRT, Chronic Care and Transition Care Management, and Medicare Shared Savings Programs.
  3. Monitor and action plan on clinical quality data including but not limited to SBIRT, UDS, HEDIS and PCMH measures.
  4. Delivery of direct-patient care and facilitating provider efficiency through the management of clinical tasks within the scope of nursing practice

• Operational Excellence

  1. Ensure compliance with all internal policies and practices, as well as local, state and federal laws and regulations.

• Relationship Management

  1. Establish and ensure collaborative, supporting relationships within the organization.
  2. Serve as a liaison to establish and maintain positive and effective relationships with key stakeholders including but not limited to the Bureau of Primary Health Care, state agencies and funding sources, regulators, health care organizations, community partners, insurance carriers, auditors, and related external resources.

ESSENTIAL FUNCTIONS/RELATIONSHIPS

• Work with the primary care team to conduct comprehensive Medicare Annual Wellness Visits for eligible beneficiaries
• Coordination and execution of patient care plans and goals with patients.
• Demonstrate compassion and non-judgmental care
• Establish a rapport with patients and build a therapeutic relationship
• Demonstrate a high level of skill at building relationships and strategic partnerships
• Work with patients to determine risk levels for substance abuse, specifically focusing on opioid abuse
• Offer educational support, referrals for treatment and help facilitate the coordination of care for clients with substance abuse disorders.
• Support engaging patients in self management for chronic diseases and substance abuse disorders
• Analyze, synthesize and communicate quality data in an accurate, objective and straightforward manner.
• Demonstrate a high level of problem solving skills. Demonstrate the ability to make critical decisions supported by substantial analysis and critical data based decision-making.
• Ability to provide high level of personal autonomy
• Ability to effectively manage conflict, promotes change and growth, and inspires high standards of performance.
• Demonstrate interpersonal savvy and influence skills with the organization’s key stakeholders, including but not limited to the Bureau of Primary Health Care, state agencies and funding sources, regulators, health care organizations, community partners, insurance carriers, auditors, and related external resources.
• Ability to build consensus and focus within the overall organization as well as within and among various business resources and strategic partners.
• Ability to travel throughout the region to monitor overall quality performance and activity, and to establish relationships with key resources and affiliates.
• Ability to routinely and creatively use and understand technology necessary to collect, retain, analyze and report critical, requisite information related to case management and quality outcomes.
• Ability to regularly and effectively communicate throughout all levels within the organization in written, verbal, and presentation formats.
• Able to provide direct-care to patients and facilitate provider efficiency through the management of clinical tasks within the Nursing Scope of Practice.
• Other duties as assigned

SUPERVISORY RESPONSIBILITY

• This position has no supervisory responsibility

POSITION TYPE AND EXPECTED HOURS OF WORK

• This is a full-time position
• Days and hours of work will be scheduled in accordance with West Cecil Health Center’s operating hours

LOCATION/TRAVEL

• Located in West Cecil Health Center and/or its qualified subsidiaries.
• Travel is primarily local during the business day, although some out-of-the-area travel may be expected.

POSITION REQUIREMENTS

Education

• Current Maryland RN license required. Completion of a BSN required and Master’s Degree in Nursing Preferred.

Experience

• Three (3) years nursing care experience preferred. Experience with quality based reimbursement models, utilization management, substance abuse, or outpatient medical practice preferred.
• BLS required.
• Demonstrate skill in a) clinical case management; b) performing complete assessments; c) monitor, assess and record patient progress against a plan of care; d) effective critical thinking skills both written and oral; e) facilitating patient access to community resources; and f) age appropriate interpersonal interactions (patients may range from newborn to geriatric adult.)
• Ability to a) communicate and collaborate effectively with both internal and external customers (Medical Staff, multiple-specialty team, management staff, external organizations and general public); b) assess, adapt, and calmly respond to changing and/or crisis environment; c) make independent decisions consistent with current policies, procedures, and ethical standards; d) prioritize work assignments and manage time effectively to complete duties; and e) assist in data analysis and computer literate in word processing, Excel, and data management skills; (f) action plan around clinical quality measures.
• Normal accessibility and mobility throughout the region required.
• Prolonged sitting and working at a computer terminal
• Standing, Bending, Walking, and Lifting 0-25 lbs
• Will sometimes have contact with blood borne pathogens and infectious, biochemical and hazardous waste.
• Required to wear appropriate PPE in delivering patient care

REPORTING RELATIONSHIPS:

Supervised by: Nurse Case Manager Supervisor

OTHER DUTIES

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

WCHC is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to age, race, color, national origin, ancestry, religion, sex, sexual orientation, pregnancy, marital status, credit history, physical or mental disability, genetic information, veteran status, uniformed service member status, or any other characteristic protected by law.